| NPI | 1811551039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-15349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 251135) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2022-08-04 |